Unique paradoxical atlantoaxial dislocation with C1-C2 facet diastases and isolated ligamentous injury to the craniovertebral junction without neurological deficits: A case report.

STUDY DESIGN

Retrospective review of the case file.

OBJECTIVE

The primary objective was to report this rare case and discuss the mechanism of dislocation and technique of manual closed reduction of C1-C2 vertebrae in such scenarios.

SUMMARY OF BACKGROUND DATA

Posterior atlantoaxial dislocation (AAD) is extremely rare and a few cases have been reported in English literature. This young man sustained a high speed car accident and survived an extreme hyperextension injury to the craniovertebral junction (CVJ) without any neurological deficits. On evaluation for neck pain he was noted with a dislocated odontoid lying in front of Atlas. There was C1-C2 facet diastases. No bony injury was noted at CVJ. Transverse axial ligament (TAL) was intact. He underwent a successful awake reduction of the dislocation. The joint had to be manually distracted, realigned, and released under the guidance of fluoroscopy. This was followed by single stage C1-C2 Goel's fusion with awake prone positioning. This patient was able to go back to work at the end of 3 months (GOS 5).

CONCLUSIONS

This condition is extremely rare, can be carefully reduced manually under adequate neuromonitoring, and requires C1-C2 fusion in the same sitting.